Medical Coding & Compliance Specialist

Job Description

Job Description

Description:

Position Summary

Audits medical records to verify coding of ICD or CPT codes following industry-standard coding guidelines. Reviews insurance payment and billing denial data to identify and recommend coding practice changes. Utilizes advanced knowledge of medical coding to review patient medical records, ensuring that documentation by providers conforms to legal and procedural requirements. Assigns specified codes to medical diagnoses and/or clinical procedures.

Essential Duties and Responsibilities

The essential functions include, but are not limited to the following:

• Represent Medical Management Specialists (MMS) in the most positive and professional manner with clients, customers, guests, and the community.
• Uphold the MMS Mission Statement: “Medical Management Specialists is committed to making a difference by providing excellent service to our clients, an outstanding work environment for our team members, and service to the community."
• Handle confidential information and protected health information (PHI) with tact and discretion as outlined in the Employee Handbook in compliance with the Health Insurance Portability and Protection Act (HIPPA).
• Reviews and interprets patient medical records within the MMS organization in order to determine the amount and nature of billable services.
• Utilizes advanced, specialized knowledge of medical coding to determine the correct codes billed and appropriate sequencing in compliance with third party payer requirements.
• Maintains up-to-date knowledge of coding and documentation requirements and offers guidance and interpretation.
• Documents audit findings with details on appropriate coding guideline references and error rates.
• Collaborates with leadership and colleagues regarding implementation of new codes and revision of charge documents.
• Performs other duties as requested or assigned by leadership.

Requirements:

Minimum Qualifications (Knowledge, Skills, and Abilities)

• Knowledge of reading, writing, mathematical and computer skills as normally acquired through completion of high school.
• Familiarity with using Microsoft O365 Apps and has the capacity to learn to use additional software as needed.
• Knowledge of professional coding, including but not limited to Emergency Department, Urgent Care, Observation, Anesthesia, Gastroenterology and Toxicology.
• Knowledge of Medical Terminology, ICD-9, ICD-10, and CPT-4 coding.
• Knowledge of anatomy and physiology.
• Required CPC Certification.
• Preferred 3+ years of experience in ED and UC medical coding.

Location

The job location for this position has the flexibility to become a hybrid/primarily remote position once the training period has been completed and the employee is able to maintain performance at the expected levels. Upon hire, the employee will be expected to work in office Monday - Friday for up to 90 days to complete all required training and onboarding functions. Candidate must maintain a permanent residence in the state of Michigan to be employed with this organization.

The company is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable.